Clustering of prostate cancer healthcare pathways in the French National Healthcare database.

Background: Healthcare pathways of patients with prostate cancer are heterogeneous and complex to apprehend using traditional descriptive statistics. Clustering and visualization methods can enhance their characterization.
Methods: Patients with prostate cancer in 2014 were identified in the French National Healthcare database ( Système National des Données de Santé -SNDS) and their data were extracted with up to 5 years of history and 4 years of follow-up. Fifty-one-specific encounters constitutive of prostate cancer management were synthesized into four macro-variables using a clustering approach. Their values over patient follow-ups constituted healthcare pathways. Optimal matching was applied to calculate distances between pathways. Partitioning around medoids was then used to define consistent groups across four exclusive cohorts of incident prostate cancer patients: Hormone-sensitive (HSPC), metastatic hormone-sensitive (mHSPC), castration-resistant (CRPC), and metastatic castration-resistant (mCRPC). Index plots were used to represent pathways clusters.
Results: The repartition of macro-variables values-surveillance, local treatment, androgenic deprivation, and advanced treatment-appeared to be consistent with prostate cancer status. Two to five clusters of healthcare pathways were observed in each of the different cohorts, corresponding for most of them to relevant clinical patterns, although some heterogeneity remained. For instance, clustering allowed to distinguish patients undergoing active surveillance, or treated according to cancer progression risk in HSPC, and patients receiving treatment for potentially curative or palliative purposes in mHSPC and mCRPC.
Conclusion: Visualization methods combined with a clustering approach enabled the identification of clinically relevant patterns of prostate cancer management. Characterization of these care pathways is an essential element for the comprehension and the robust assessment of healthcare technology effectiveness.
Competing Interests: 1Jérémy Jové, Régis Lassalle, Dunia Sakr, Magali Rouyer, Patrick Blin, Cécile Droz‐Perroteau, and Nicolas H. Thurin are researchers at Bordeaux PharmacoEpi, a research platform of Bordeaux University and its subsidiary the ADERA, which performs financially supported studies for public and private partners in compliance with the ENCePP Code of Conduct. Marine Gross‐Goupil declares personal fees and nonfinancial support from Janssen, Sanofi, Astellas, Ipsen, Amgen, and Pfizer. The remaining authors declare no conflict of interest.
(© 2022 The Authors. Cancer Innovation published by John Wiley & Sons Ltd. on behalf of Tsinghua University Press.)